Neoadjuvant Chemo Possibly a Better Option in High-Grade UTUC Cases

Patients with high-grade upper tract urothelial carcinoma who respond to neoadjuvant chemotherapy have a reduced risk of death following surgery compared with those who receive adjuvant chemotherapy, a study found.

Among
patients undergoing surgery for high-grade upper tract urothelial carcinoma,
those who respond to neoadjuvant chemotherapy (NAC) may have a survival advantage
over those who receive adjuvant chemotherapy (AC), according to a new study.

“Our
study suggests that there is a survival advantage for patients who achieve a
response, even if partial, after NAC, while patients who do not respond tend to
harbor a worse prognosis with respect to patients who receive AC,” Alberto
Martini, MD, of the Icahn School of Medicine at Mount Sinai in New York, and
colleagues concluded in Urologic Oncology.
“Our results are hypothesis-generating and further studies aimed at identifying
potential responders to NAC are warranted.”

Dr
Martini’s team studied 936 patients treated with radical nephroureterectomy for
upper tract urothelial carcinoma (UTUC). Of these, 128 (14%) received NAC and
808 (86%) received AC. The investigators found no difference in overall
survival (OS) between the groups. Relative to AC, however, patients who
responded to NAC (demonstrating a pT stage at least 1 category lower than the
pre-chemotherapy cT stage along with pN0) had a significant 55% reduced risk of
death, whereas those who did not respond to NAC had a significant 41% increased
risk of death, Dr Martini and his collaborators reported.

For the study, Dr Martini’s team abstracted information from the National Cancer Database. The study population had a median age of 69 years and was 63% male. The investigators defined AC as the administration of chemotherapy within 6 months after surgery and NAC as administration of chemotherapy within 6 months prior to surgery.

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